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Service development
PTH-126 A Functional Model of of a ‘Seven Day Acute Gastroenterology Service’: Looking Beyond Out-Of-Hours Endoscopy
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  1. A Jawhari1,
  2. L Meran1,
  3. A McCarthy2,
  4. N Lewis3,
  5. G Aithal4
  1. 1Gastroenterology, NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at the Nottingham University Hospitals and University of Nottingham
  2. 2Gastroenterology, Nottingham University Hospitals
  3. 3NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at the Nottingham University Hospitals and University of Nottingham, Nottingham, UK
  4. 4Hepatology, NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at the Nottingham University Hospitals and University of Nottingham, Nottingham, UK

Abstract

Introduction Early involvement and management by specialists has been shown to have a favourable impact on outcomes in a number of acute medical conditions. Increased patient mortality at weekends has also been attributed to limited access to specialist services. While an increasing number of hospitals provide an out-of-hours service for upper gastrointestinal bleeding, examples of a comprehensive acute Gastroenterology services are infrequent.

Methods In January 2007, we established an acute gastroenterology service to provide consultant-lead assessment and management for all patients identified through acute servieces with symptoms related to gastrointestinal and hepato-pancreatico-biliary conditions. The consultant of the week lead and delivered the service supported by a registrar and a dedicated inpatient endoscopy team, free from any commitment to elective services. Inpatient care was supported by daily consultant led ward rounds. We achieved the ‘critical mass’ to deliver this service by consolidating all inpatient work on on site.

Results Mean LOS of all patients discharged with a gastroenterology HRG, from the specialist gastroenterology ward was 7.6 days, and from non-specialist medical beds was 9.6 days. Overall the specialist gastroenterology ward provided care for 1.8 times more patients compared with other Medical wards of the same size at NUH. Actual mean LOS (for the period of 2011–2012) was significantly shorter than the ‘expected’ LOS, and than mean peer LOS for 4 main diagnostic categories (table) with no significant increase in readmission rates. Discharge rates were maintained at the same level during the weekend (mean 4 discharges per weekday and on Saturday, with a peak of 6 discharges on Fridays and a dip to a mean of 3 discharges on Sunday.

View this table:
Abstract PTH-126 Table 1
Abstract PTH-126 Figure 1
Abstract PTH-126 Figure 1

Conclusion Specialist led care can be provided to all patients with acute gastrointestinal and hepato-pancreatico-biliary conditions. A functional 7-day ‘acute gastroenterology’ can be sustained to provide high quality and intensity of care with favourable outcomes.

Disclosure of Interest None Declared.

https://doi.org/10.1136/gutjnl-2013-304907.613

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